Challenges Primary Care Providers Face in Identifying Occupational Asthma

One third of adults with diagnosed asthma may not have a current diagnosis
One third of adults with diagnosed asthma may not have a current diagnosis
Researchers identified factors leading to late or missed diagnosis of occupational asthma by primary care providers.

In a qualitative study published in BMJ Open Respiratory Research, investigators suggested 4 challenges primary care physicians face in identifying occupational asthma.

To determine obstacles in identifying occupational asthma, researchers in the United Kingdom interviewed 11 health-care professionals (HCPs) from urban and rural areas (8 general practitioners and 3 nurses) to assess organizational factors, beliefs, and behaviors that hindered identification.

Interviews uncovered 4 broad areas/themes affecting identification of occupational asthma: training and experience, perceptions and beliefs, systems constraints, and variation in individual practice.

Various subthemes were determined. With respect to training and experience, for instance, lack of exposure during medical school, postgraduate training, and on-the-job were cited. As for perceptions and beliefs, identified subthemes included beliefs about the occurrence of occupational asthma and perceived risks/benefits of an occupational asthma diagnosis. Subthemes related to systems constraints included time constraints in the office and lack of continuity of care. Those linked to variation in individual practice included differences in interviewing technique and different thresholds and preferences for referral to specialists.

Some takeaways from the study include that asthma care may not be organized in a fashion that supports deduction of an occupational etiology. Another point is that primary HCPs who deliver asthma care may lack training and clinical acumen in cases of occupational asthma and express negative beliefs about the occurrence of this condition.

The authors state that even though specific guidelines are published regarding the identification and referral of suspected occupational asthma, primary asthma care is limited with regard to the recognition of the condition and the referral to a specialist. Lack of education and clinical experience play an additional role. These factors can influence clinician beliefs and actions.

“Whether screening individuals with asthma in primary care for [occupational asthma] is helpful, and the optimal tool for doing so, are both currently unknown and require evaluation,” noted the authors.

This study has limitations. The researchers worked in the hospital and not in the clinic, thus themes could have been missed. The sample lacked diversity, with no physicians-in-training. All routes of general practitioner training were not represented due to the small sample size. Another limitation was the location of the study, which could limit generalizability


Walters GI, Barber CM. Barriers to identifying occupational asthma among primary healthcare professionals: a qualitative study. BMJ Open Respir Res. Published online August 6, 2021. doi:10.1136/bmjresp-2021-000938